Novo Nordisk raises 2026 guidance as Wegovy pill tops 2m prescriptions
Novo Nordisk has raised its full-year 2026 guidance following a first quarter in which its oral semaglutide product, Wegovy pill, exceeded two million cumulative prescriptions in the United States — a record the company describes as the strongest-ever GLP-1 volume launch in that market.
The Danish pharmaceutical group reported adjusted net sales of DKK 70,063 million for Q1 2026, a decline of 4% at constant exchange rates (CER), as lower realised prices in the US more than offset volume growth. Adjusted operating profit fell 6% at CER to DKK 32,858 million. On a reported basis, which includes a USD 4.2 billion non-recurring provision reversal related to the 340B Drug Pricing Program in the United States, net sales grew 32% and operating profit rose 65% at CER — figures that substantially flatter the underlying trading position.
Chief executive Mike Doustdar said Wegovy pill is "defining a novel category as the only oral peptide for the treatment of obesity," adding that the strong performance, together with continued growth in international markets, underpinned the decision to raise guidance. Novo now expects adjusted sales and adjusted operating profit growth for 2026 in the range of -4% to -12% at CER, an improvement on the previously stated range.
Pipeline momentum
Beyond the Wegovy pill launch, the quarter delivered several additional regulatory and clinical milestones. The FDA approved Wegovy HD — an injectable semaglutide formulation at 7.2 mg — in March; the product launched in the US on 7 April. Data from the STEP UP trial showed Wegovy HD delivered a mean weight loss of 20.7%, positioning it above the weight-loss efficacy reported for the standard injectable Wegovy dose in earlier trials.
The company also received FDA approval for Awiqli, described in the release as the first once-weekly basal insulin for type 2 diabetes. In sickle cell disease, the investigational compound etavopivat met both co-primary endpoints in the Phase 3 HIBISCUS trial — a result that, if confirmed in a regulatory submission, would represent Novo's first approved therapy in haematology. The zenagamtide AMAZE Phase 3 programme for obesity was also initiated during the quarter. International launches of Wegovy pill are expected to begin in the second half of 2026, pending regulatory decisions in the relevant jurisdictions.
Market context and competitive read-across
The pricing pressure visible in Novo's US adjusted sales figures is a sector-wide dynamic. Pharmacy benefit managers and large payers have extracted increasing rebates across the GLP-1 class as competition between Novo's semaglutide franchise and Eli Lilly's tirzepatide (Mounjaro and Zepbound) has intensified. Novo's US Operations adjusted sales fell 11% at CER in the quarter, a notable deterioration that signals the extent to which volume growth is currently being absorbed by price concessions rather than flowing through to revenues.
The oral semaglutide launch, however, represents a genuine product-category distinction. No competing oral GLP-1 peptide is currently approved, giving Novo a period of exclusivity in that format. Lilly's orforglipron, an oral small-molecule GLP-1 receptor agonist, is in late-stage development and reported Phase 3 data in 2025; should it gain approval, it would enter a different chemical class but target the same patient population. Analysts will also be watching whether the higher-dose injectable Wegovy HD can recapture patients who are considering the emerging class of dual and triple receptor agonists.
The raised 2026 guidance, while still projecting a decline in adjusted sales and profit at CER, signals management's confidence that volume trends — particularly outside the US, where adjusted sales grew 6% at CER — will cushion the ongoing US pricing headwind through the remainder of the year.